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Enrolling 1 Student

ESVCA West Elk USD 282 Enrollment Application (1)

Parent/Legal Guardian Section

This section should be completed by the parent/legal guardian acting as the primary point of contact for Eschool Virtual Charter Academy.
Parent Name(Required)
Please list the name of the parent/guardian who is the primary point of contact for the student being enrolled.
MM slash DD slash YYYY
Preferred Form of Contact(Required)
Parent's Household Address(Required)
The student’s family must have a legal residence in the state of Kansas in order to attend public school. Please list the legal Kansas residence at which the student resides.
Is the parent/legal guardian a member of the active uniformed military services of the United States and on full time active-duty status or active-duty orders?(Required)

Emergency Contact

Please list the name and phone number of someone, other than you, that can be reached in the event of an emergency.
Emergency Contact Name(Required)

Student Section

Student Name(Required)
Gender (As shown on birth certificate)(Required)
MM slash DD slash YYYY
Is Student Hispanic or Latino(Required)
Race: How does Student Identify?(Required)
Is the above listed student being served on an Individualized Education Program (IEP)?(Required)

Previous School District

The following information will help our Registrar more accurately obtain proper student records for processing, enrollment, and scheduling of classes.


Field Trip(Required)